CHAPTER 10

Ethics

Nazi Medical Horrors Revealed at New Trials

By DANA ADAMS SCHMIDT

Following close upon the exposure of the cosmic crimes of the war lords and politicians tried before the International Military Tribunal, an American Military Government Tribunal at Nuremberg is now ferreting out details of crimes committed by a part of the German medical profession so hideous that the Nazis bent every effort to keep them secret.

The trial of twenty doctors and scientists and three laymen, now nearing its end, has exposed ghoulish experiments on living men and women and a program of extermination by gassing, lethal injection and sterilization conducted in remote clinics, asylums and concentration camps.

Specifically, the case has become a trial of the Nazi racial doctrine. For the victims of experiments and extermination were drawn from “inferior peoples”—Russians, Poles and other Slavs, and Jews and gypsies. The experiments were pretended to further military medical science, but were really to devise new methods of inconspicuous mass killing, of “inferior, useless or undesirable people.” This is what Brig. Gen. Telford Taylor in his opening address called the science of thanatology. To it certain German medical men, abandoning the Hippocratic oath and all codes of ethics, devoted themselves. Some of the men who bore top administrative responsibility for this activity, such as Dr. Leonard Conti, chief of civilian medical services, committed suicide at the end of the war. The others today blame orders imposed by Hitler and Himmler.

Fields Explored

Gerhardt Rome, an expert in tropical medicine with an international reputation, is professionally the most “distinguished.” Today he professes to despise the unscientific and barbarous activities of the others in the dock but he provided fly eggs for malaria experiment on inmates of the Dachau concentration camp, causing 300 or 400 deaths.

Lesser administrators and doctors performed the gruesome tasks. In addition to those mentioned the subjects of their experiments included the effects of high altitude and freezing, poisoning induced by bullets and woodshavings or ground glass rubbed into wounds, spotted fever, bone and muscle transplanting, uses of sulphanilamide, and effects of mustard gas and incendiary bombs.

In a report on one of the high altitude experiments at Dachau defendants Siegfried Ruff and Hans Romberg described as follows the reactions of a Jewish delicatessen clerk who, deprived of an oxygen mask, had been raised to an atmospheric elevation of 47,000 feet inside a low pressure chamber:

“Spasmodic convulsions, arms stretched stiffly forward, sits up like a dog, legs spread stiffly apart, agonal convulsive breathing, convulsions and groaning, yells aloud, convulses arms and legs, grimaces, bites his tongue, does not respond to speech, gives the impression of someone who is completely out of his mind.”

Victims Frozen to Death

Also at Dachau defendants under the direction of an arch fiend named Sigmund Rascher, now believed dead, exposed victims to freezing temperatures for fourteen hours or immersed them in near-freezing water for three hours. Herta Oberheuser, the lone woman on trial, was charged with having selected young and healthy inmates of the Ravensbruck women’s camp for experiments. Karl Gebhardt, surgical adviser to the Waffen SS, is charged with having gone to Ravensbruck to perform sterilizations and of having removed a bone from the shoulder of a healthy Polish woman to transplant it on the shoulder of an ailing friend. Victor Brack, who handled the administrative details of the euthanasia program, wrote recommendations that Russians and others should be sterilized by X-ray emanating from a counter before which they would be required to pass, ostensibly to fill out forms.

Equally horrifying practices have come to light in the trials of forty-three members of the staffs of the Eighberg Kaimenof and Hadamar medical institutions before a German court in Frankfort on the Main. At Hadamar, naked men and women were driven into a “shower” room where they were gassed and later cremated until the ceaseless smoke from the crematorium induced the Bishop of Limburg to protest to Hitler.

Defense Denies Race Theory

None of the defendants before the United States or German courts has dared to invoke the Nazi motive for his act. This was that the victims were physically, mentally or racially inferior and must be eliminated to make way for the pure-bred master race. Instead they refer to a higher authority that they dared not oppose.

They maintain, also, that they thought the victims of the experiments were volunteers, condemned criminals who had received a promise of pardon if they survived or that the mass killings were merciful euthanasia.

All this has been faithfully reported to the German public. Two dozen German correspondents are in attendance in Nuremberg, including representatives of the German news agencies of all four zones. The United States zone radio network broadcasts three fifteen-minute commentaries on the trials. One this week was devoted to the Strasbourg University skeleton collection, for which eighty-six representative Jewish types were selected and slaughtered.

Nearly 100 German spectators observe the Nuremberg medical trials daily. They are checked only for criminal records before admission and many erstwhile Nazis are known to attend. Frequently groups of medical students ask for passes.

The German public at large, however, has heard these or similar stories over and over during the long series of trials.

Germans Satiated

Today Germans are satiated with horror. Many a German wearily switches off the radio when talk on the concentration camp atrocities begins. With satiation appear to have come these reactions:

1. Almost all Germans will admit today that these things happened—that they are not mere propaganda.

2. They will hasten to add they knew nothing of such horrors at the time and were certainly in no way responsible. They knew there were concentration camps but this, never.

3. While there is no sign of any feeling of collective guilt, there is a widespread feeling of revulsion against the acts committed by some leading Nazis.

Few observers would risk the opinion that German reaction goes much beyond revulsion at present. But it is the higher purpose of the trials, as laid down by General Taylor, to lead the Germans to the broader conclusions that such crimes epitomize the Nazi way of life and that they and other disasters followed inevitably when the Germans allowed their individual reason and conscience to be swept away by a dictator with an irrational and immoral doctrine of racial superiority.

In the long run it will be up to German writers, politicians and leaders in all fields to make this an integral part of German thought.

The initial impulse is in the hands of United States judges and attorneys in charge of the trials. Among them are Justice Walter B. Beals, former Chief Justice of the Supreme Court of the State of Washington; H. L. Sebring, judge of the Supreme Court of Florida, and Johnson T. Crawford, on the bench of the Oklahoma District Court for twenty-two years. An alternate is Lieut. Col. V. C. Swearinger, former assistant attorney general of Michigan, who served as a combat intelligence officer during the war.

The prosecuting attorney is James M. McHaney of Little Rock, Ark., formerly of the New York law firm of Cabin, Gordon, Salhry & Reindal. His deputy is Alexander G. Hardy of Boston, Mass., veteran of three years’ service with the Navy.

March 2, 1947

Many Scientific Experts Condemn Ethics of Cancer Injection

By JOHN A. OSMUNDSEN

Medical research circles are buzzing over the disclosure last week of experiments in which persons were injected with living cancer cells without their knowledge.

Discussion centers less on the legality of the experiments than on the ethics and morality of them. Opinion is varied, but it leans heavily toward condemnation of the failure to inform the subjects of the research about exactly what was being done to them.

Varied reactions were expressed in interviews with several scientists active in clinical research and other authorities who have studied the ethics and morality of human experimentation.

Judgment ranged from the opinion that the experiments were “completely indefensible” on ethical grounds, and should not have been conducted at all, to the view that the experimenters were justified in the way they did their research. Both extremes were minority opinions.

The majority expressed the view that the studies were important and productive and should have been done, but that it was unethical not to tell the subjects that they were receiving living cancer cells instead of just “cells,” as the experimenters had described the tests to the patients.

Scientists Disagree

The scientists who did this work, on the other hand, insisted that to tell many of the patients who took part in the research that they were receiving cancer cells would have been unethical.

The reason they gave for this was that a person who has cancer and will not admit it to himself—or has not been told of it—would be forced into the realization of his condition and that this would be psychologically harmful to him.

The problem came to light last Monday when it was disclosed that 22 patients at Brooklyn’s Jewish Chronic Disease Hospital had been injected with living cancer cells with their consent but without their knowing what the injections really consisted of.

It came out subsequently that nearly 300 other patients at the Sloan-Kettering Institute for Cancer Research and Memorial Hospital for Cancer and Allied Diseases had also participated in this work and that many of them had, similarly, not been told that the injections contained living cancer cells.

A third group, inmates of the Ohio State Penitentiary in Columbus, Ohio, volunteered for the tests, knowing that the injections consisted of cancer cells.

The research, under the direction of Dr. Chester M. Southam of Sloan-Kettering, has been going on for 10 years. It is aimed at studying the nature of the body’s defense mechanisms—the immune reactions—in healthy persons, cancer patients and persons suffering from chronic diseases other than cancer.

The important outcome of the study so far is that a cancer patient’s immune mechanisms are deficient, compared with those of the two other groups. The nature of the deficiency is now being studied.

Possible fruits of the work include the knowledge of how to help cancer patients fight their own tumors with immune reactions, how to manipulate the reaction so that grafts of foreign tissues would be practicable, and how to transfer immunity to disease from one person to another.

Value Not Questioned

Thus, there has never been any question of the potential value of the research.

Neither has there been much doubt about the safety of experiments. Sufficient experience with the injection of cancer cells in animals and in humans—many of them scientists, or volunteers who were told what they were getting—has shown that the risk of, say, causing cancer by the injections was considered to be very low.

Nor has there been any question of the competence and high standards of Dr. Southam, who is recognized as one of the world’s leading authorities in this field.

Two supporters of the manner in which the work was done, in fact, declared that if the same procedure had been followed by almost any scientist other than Dr. Southam they would have thought it unethical, their regard for him was so high.

Rather, the question of ethics has been raised over the matter of whether the scientists usurped the rights of the subjects to make their own decisions about taking part in the experiments.

It was pointed out by several critics of the work that these experiments were distinctly different from the sort of clinical research that is aimed at evaluating the efficacy of a new drug or vaccine or other therapeutic procedure.

Such studies, they pointed out, are of direct potential benefit to the individual being tested. By contrast, the possibility of immediate benefit to the subject was not a consideration of the Sloan-Kettering project.

Moreover, the critics said, because a physical act on the person of the subject was involved in the research, a finite—though small—risk was involved. They asserted that this called for the complete disclosure to the subject of the nature of the injection.

In this respect, Dr. Southam said in an interview:

“It is not necessary to present [the subject] with what you feel are inconsequential data and [it is] unethical to ram down his throat information which is detrimental to his condition.”

Asked whether it would not be possible to use as subjects cancer sufferers who knew of their condition and so would not suffer from the revelation, Dr. Southam replied:

“You just don’t know what the patient really knows or has accepted by himself.”

Dr. Southam was asked why the subjects at Jewish Chronic Disease Hospital who did not have cancer were similarly deprived of the knowledge that the injections contained living malignant cells.

He replied that the preparation of the patients and acquisition of their consent was left up to Jewish Hospital officials, who had decided simply to follow procedures that had been used for so long by the Sloan-Kettering team.

The controversy gains significance because of the growing amount of human experimentation. The ethics and morality of such experimentation have been discussed in medical journals in this country and abroad and by panels in medical schools.

Code Adopted

An ethical code has been adopted by some institutions in this country and elsewhere: the Nuremberg Code for Permissible Human Experiments.

The first article of that code states:

“The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision.”

State health officials are reported to be studying whether a stricter code of ethics for clinical research would be needed or justified.

The board now has no regulations about what kind of consent, written or oral, is required from patients in scientific experiments.

Although many hospitals “do not go in for ‘paper,’” as one authority phrased the attitude toward written consent, some experts believe that this is the only ethical form of agreement and that vocal consent is not enough.

January 26, 1964

Physician Scores Tests on Humans

By JOHN A. OSMUNDSEN

Augusta, Mich.—A noted medical researcher assailed today what he said “seem to be breaches of ethical conduct in experimentation” on humans.

The critic was Dr. Henry K. Beecher, Henry I. Dorr Professor of Research in Anesthesia at Harvard University and chief anesthetist at Massachusetts General Hospital.

He attacked experiments performed on persons without their informed consent that “cannot by any stretch of the imagination be construed as for [their] benefit.”

Dr. Beecher cited cases in which 23 charity patients died in 1963 because they were deprived of the standard treatment for typhoid fever. He also mentioned 25 United States servicemen who were “crippled for life” in 1956 because they were denied treatment that would have prevented the development of rheumatic fever.

Instances of such practice, the scientist said, “are by no means rare but are almost, one fears, universal” and are increasing as the amount of experimentation on man grows.

Dr. Beecher Countered

“Dr. Beecher’s views came under immediate attack from other medical scientists who attended a two-day symposium on clinical research given by the Upjohn Company here.

One called the criticism “a gross and irresponsible exaggeration” and another declared that the charges would do serious damage to medical research in this country.

Dr. Beecher emphasized that he was not referring to the clinical testing of new drugs or of new procedures that are done for the patient’s good. He indicated that obtaining the “informed consent” of the patient in such instances was not required because “the necessary consent is understood in the presentation of the patient to the physician for treatment.”

Dr. Beecher was concerned about the use of hospitalized patients, military personnel, convicts, medical students and laboratory personnel for experiments in which the subjects are not asked for their permission nor told what is being done and what the risks might be.

The Boston physician asserted that such cases of clinical research “are easy to find.” A British colleague has compiled a list of 500 examples, he said.

In his paper “Ethics and the Explosion of Human Experimentation,” Dr. Beecher cited 50 examples of clinical experiments that he thought were ethically questionable.

These are some of the examples Dr. Beecher described.

Last year, 18 children ranging in age from 3› months to 18 years old were selected from a group about to undergo surgery for congenital heart disease. Of that number, 11 were to have their thymus glands removed, the remaining seven to serve as controls, retaining that gland in their chests. In addition, the skin from an unrelated adult was grafted to the chest wall of each child. The experiment was described as “part of a long-range study of the growth and development of these children over the years.”

Heart Experiment Cited

In another case in 1960, seven patients were put under general anaesthesia and a double needle was thrust through their chest so that one part entered a chamber on the right side of the heart and the other a chamber on the left.

“No indication is given as to the source of the patients or the relevancy of this test to their required medical care,” Dr. Beecher said. He observed that the experimenters who did the work believed that their method “may be valuable clinically as soon as safety has been confirmed by additional work.”

Another study in 1962 of the effect of a drug on liver function was performed on 50 inmates of a children’s center who included mental defectives and juvenile delinquents. None had a disease worse than acne, Dr. Beecher said, yet some were given repeated doses of the drug, which caused abnormal liver function for as long as five weeks.

In disagreement with Dr. Beecher were Dr. Thomas Chalmers, professor of medicine at Tufts University, and Dr. David Rutstein, professor of preventive medicine at Harvard Medical School.

Neither, however, disagreed with Dr. Beecher’s contention that humans should not be subjected without their knowledge and consent to experiments that could not benefit them.

Dr. Beecher said that informed, paid volunteers were about the only type of acceptable subjects for such experimentation.

March 24, 1965

Willowbrook Doctor Is Striving to End 2 Snake Pits

By HOMER BIGART

At Willowbrook State School for the mentally retarded, two locked wards merit the term snake pits.

Wards A and C in Building 9 of the Staten Island institution each contain 75 profoundly retarded and severely disturbed men. Kept docile by massive doses of tranquillizers, they represent the total negation of human dignity and hope.

“With proper facilities and adequate staff, something could be done to improve the condition of these men,” said Dr. Jack Hammond, director of the school, as he unlocked the door to Ward C for a visitor late Friday. “But there is nothing I can do now.”

The door swung open. A staff assistant had prepared the visitor for shock: “You’ll be lucky if you don’t see a patient drinking from a lavatory.”

The dayroom, a few steps beyond the toilets, was crowded with nude, shapeless male bodies.

Slumped, Dozing, Staring

Some of the men, slouched against the drab walls, were standing in puddles of their own urine. Others shambled about, muttering incoherent sounds. There were heavy benches in the center of the room, and these were filled with slumping men, dozing or staring vacantly at the floor.

There was a violent stench. The men were bathed twice a day, Dr. Hammond said, but were always fouling themselves.

The ward attendant was a woman. In her white uniform, looking as placid as though she were in a well-ordered hospital, the attendant was surrounded by milling, grunting men.

Dr. Hammond said it was very difficult to get male attendants to work in this ward. Actually, the woman attendant was quite safe from sexual assault, he said, because these patients lacked the psycho-sexual development to be interested in heterosexual acts.

This was the ward that had prompted Senator Robert F. Kennedy to describe the institution as “filthy” and “zoo-like.” It was the ward where, two months ago, one man slugged another in the neck, fracturing his larynx so that the man died quickly of suffocation.

Wards A and C are “disgraceful,” Dr. Hammond said, so crowded that it is quite impossible to prevent assaults, even homicides. There have been five violent deaths in the institution—two of them homicides—in the 14 months of Dr. Hammond’s tenure.

All could have been avoided with adequate staffing, Dr. Hammond said in a voice cold with anger.

Instead of herding 75 severely disturbed men in one ward, Dr. Hammond would put them in groups of no more than 15 each and give them therapeutic programs. But at the moment there aren’t even enough attendants to toilet-train these men.

“They are being de-humanized,” Dr. Hammond said. “Nobody talks to them.”

The other wards, even the wards for children, were also desperately understaffed. And although conditions there seemed tolerable, Dr. Hammond warned that unless the children received more training, attention and human contact, many might become as profoundly retarded and disturbed as the men in Building 9.

In one of the children’s wards, two attendants were trying to feed 40 children.

An Occasional Whimper

A stillness, unusual in children’s wards, was broken only by an occasional whimper. Several mongoloid children were in the room and there were a few others who were afflicted with hydrocephalus, a condition caused by the accumulation of fluid within the head.

On a wheelchair sat a startling figure. Irene, a 6-year-old girl with hydrocephalus, looked at first like a doll whose maker had attached a head grotesquely large to the image of a normal child’s torso.

Irene’s head rocked slowly back and forth, rhythmic as the pendulum of a clock, but she was in no pain and she gave a sweet smile while Dr. Hammond spoke to her.

Turning to the visitor, Dr. Hammond said: “If these retarded children were in the community and able to live at home, they’d be attending special classes in public schools; they’d be in school from 9 a.m. to 3 p.m., and there would be one teacher for every 15 children.

“Here,” and his voice became indignant, “only about 15 of 186 children in this building are exposed to a teacher for one and one-half hours a day.”

Dr. Hammond began a fight for more facilities and more staff soon after taking office in July, 1964. He reported a “most deplorable condition” at Willowbrook to his chief, the late Dr. Paul Hoch, Commissioner of the New York State Department of Mental Hygiene.

Shut-off Urged

At that time the institution was even more crowded than now, with more than 6,000 patients squeezed into buildings designed for little more than 4,000.

Dr. Hammond urged the shut-off of all new admissions except for children under 5. Dr. Hoch approved the recommendation and ordered admissions closed for a 90-day period, after which they were reopened on a selective basis and only to those buildings where a vacancy occurred within the allowed capacities.

There have been no vacancies except in buildings for children under 5, and for which there is a waiting list of almost 400. For those over 5, there is now a waiting list of nearly 500 names.

When he came to Willowbrook, Dr. Hammond discovered to his “utter amazement” that patients were hastily screened on the day of admission and immediately assigned to buildings. This had resulted in the mixing of dangerous and aggressive persons with patients who were docile and only moderately retarded.

With Dr. Hoch’s approval, Dr. Hammond instituted a preadmission evaluation of each patient and established a diagnostic and counseling center for the careful screening of applicants for admission.

There are still “about three or four” dangerous individuals at Willowbrook. Dr. Hammond has asked the State Supreme Court for authority to transfer three of them to the Eastern Correctional Institution at Napanoch. The necessary papers were filed several months ago, but the patients are still in Willowbrook.

One, with a history of arson, has set two fires within the institution, Dr. Hammond said. In July, 1964, the court sent back the papers, suggesting they be submitted through the District Attorney’s office. This was done, but there has been no further action.

Plans Outlined

In his report to Dr. Hoch a year ago, Dr. Hammond also outlined some long-range plans for increasing the therapeutic and training services.

He said he received prompt and complete backing from both Dr. Hoch and the present Acting Commissioner, Dr. Christopher F. Terrance. And Governor Rockefeller always supported the department’s budget recommendations, he added.

But getting the money out of the Legislature was not easy. The Governor asked for a $100 million increase in the current budget for the department, which had spent $280 million last year. The Legislature allowed only a $30 million increase.

What Senator Kennedy said about Willowbrook was true enough, Dr. Hammond said yesterday, but he wished that the Senator had added a few kind words about his overworked staff and the fact that some happy developments were taking place there.

Research Sought

These included a research program by the New York University School of Medicine, which is trying to develop a measles vaccine (a mother afflicted with German measles in pregnancy can give birth to a mentally defective child), and the construction of a $7 million Institute for Basic Research in Mental Retardation at the east end of the campus.

There is also some hope for getting adequate custodial help.

Dr. Hammond has been authorized five additional physicians (there are now 29), 182 more attendants, an additional psychologist and two social service workers.

But there is no immediate prospect of relieving the overcrowding, and this unpleasant condition is the main reason for the excessive turnover in employees.

Nearly one out of every four new employees quits after only two months at Willowbrook.

September 13, 1965

U.S. Issues Rules on Human Testing

By HAROLD M. SCHMECK JR.

The Department of Health, Education and Welfare published today regulations codifying its policies for protecting the rights of human subjects of research.

A cardinal principle of the code is a regulation that require review committees at every institution doing research with support from the department if the research involves human subjects.

Another basic principle is that the subjects of the research be informed of the risks and potential benefits and that they voluntarily consent to take part, with the understanding that they can withdraw at any time.

The regulations also specify that the research must offer potential benefits to patients or to scientific knowledge sufficient to justify the risks and discomforts the studies might involve.

The Secretary of Health, Education and Welfare is given broad discretion to rule on the adequacy of the committees and to restrict the use of specific research procedures and the types of individual taking part as subjects of research.

While the specifics addressed in the new regulations are aimed largely at problems of medical research, the language appears to be broad enough to include also research in education, sociology and even such items as experiments in income maintenance for welfare patients. Some persons familiar with the regulations say this aspect raises potential problems. For example, would informed consent be necessary before a teacher could introduce an innovation in teaching arithmetic to elementary school pupils?

Some Untouched Areas

The new regulations do not contain specific guidelines for such controversial subjects as psychosurgery, research on the human fetus or research involving prisoners. Proposed regulations concerning these areas are to be publicized this summer.

In general, an official involved in drafting the regulations said today, the statement published in the Federal Register amplifies and codifies policies that have been developed in the department over the last decade.

Review committees and informed consent, for example, have long been required. The new regulations give specifics such as the requirement that membership in a review committee must not be limited to employees of the institution where the research is done or to professional groups such as physicians, psychologists or sociologists.

The research subject’s informed consent is defined in terms of the Nuremberg code: “The knowing consent of an individual or his legally authorized representative, so situated as to be able to exercise free power of choice without undue inducement or any element of force, fraud, deceit, duress or other form of constraint or coercion.”

The Nuremberg code, covering the ethics of medical research, was drawn up in connection with the trials of war criminals after World War II.

The health department’s regulation concerning the subject’s right to withdraw from a research project specifies that this shall be “without prejudice.”

May 31, 1974

U.S. Apologizes for Syphilis Tests in Guatemala

By DONALD G. MCNEIL JR.

From 1946 to 1948, American public health doctors deliberately infected nearly 700 Guatemalans—prison inmates, mental patients and soldiers—with venereal diseases in what was meant as an effort to test the effectiveness of penicillin.

American tax dollars, through the National Institutes of Health, even paid for syphilis-infected prostitutes to sleep with prisoners, since Guatemalan prisons allowed such visits. When the prostitutes did not succeed in infecting the men, some prisoners had the bacteria poured onto scrapes made on their penises, faces or arms, and in some cases it was injected by spinal puncture.

If the subjects contracted the disease, they were given antibiotics.

“However, whether everyone was then cured is not clear,” said Susan M. Reverby, the professor at Wellesley College who brought the experiments to light in a research paper that prompted American health officials to investigate.

The revelations were made public on Friday, when Secretary of State Hillary Rodham Clinton and Health and Human Services Secretary Kathleen Sebelius apologized to the government of Guatemala and the survivors and descendants of those infected. They called the experiments “clearly unethical.”

“Although these events occurred more than 64 years ago, we are outraged that such reprehensible research could have occurred under the guise of public health,” the secretaries said in a statement. “We deeply regret that it happened, and we apologize to all the individuals who were affected by such abhorrent research practices.”

In a twist to the revelation, the public health doctor who led the experiment, John C. Cutler, would later have an important role in the Tuskegee study in which black American men with syphilis were deliberately left untreated for decades. Late in his own life, Dr. Cutler continued to defend the Tuskegee work.

His unpublished Guatemala work was unearthed recently in the archives of the University of Pittsburgh by Professor Reverby, a medical historian who has written two books about Tuskegee.

President Álvaro Colom of Guatemala, who first learned of the experiments on Thursday in a phone call from Mrs. Clinton, called them “hair-raising” and “crimes against humanity.” His government said it would cooperate with the American investigation and do its own.

The experiments are “a dark chapter in the history of medicine,” said Dr. Francis S. Collins, director of the National Institutes of Health. Modern rules for federally financed research “absolutely prohibit” infecting people without their informed consent, Dr. Collins said.

Professor Reverby presented her findings about the Guatemalan experiments at a conference in January, but nobody took notice, she said in a telephone interview Friday. In June, she sent a draft of an article she was preparing for the January 2011 issue of the Journal of Policy History to Dr. David J. Sencer, a former director of the Centers for Disease Control. He prodded the government to investigate.

In the 1940s, Professor Reverby said, the United States Public Health Service “was deeply interested in whether penicillin could be used to prevent, not just cure, early syphilis infection, whether better blood tests for the disease could be established, what dosages of penicillin actually cured infection, and to understand the process of re-infection after cures.”

It had difficulties growing syphilis in the laboratory, and its tests on rabbits and chimpanzees told it little about how penicillin worked in humans.

In 1944, it injected prison “volunteers” at the Terre Haute Federal Penitentiary in Indiana with lab-grown gonorrhea, but found it hard to infect people that way.

In 1946, Dr. Cutler was asked to lead the Guatemala mission, which ended two years later, partly because of medical “gossip” about the work, Professor Reverby said, and partly because he was using so much penicillin, which was costly and in short supply.

Dr. Cutler would later join the study in Tuskegee, Ala., which had begun relatively innocuously in 1932 as an observation of how syphilis progressed in black male sharecroppers. In 1972, it was revealed that, even when early antibiotics were invented, doctors hid that fact from the men in order to keep studying them. Dr. Cutler, who died in 2003, defended the Tuskegee experiment in a 1993 documentary.

Deception was also used in Guatemala, Professor Reverby said. Dr. Thomas Parran, the former surgeon general who oversaw the start of Tuskegee, acknowledged that the Guatemala work could not be done domestically, and details were hidden from Guatemalan officials.

Professor Reverby said she found some of Dr. Cutler’s papers at the University of Pittsburgh, where he taught until 1985, while she was researching Dr. Parran.

“I’m sifting through them, and I find ‘Guatemala … inoculation …’ and I think ‘What the heck is this?’ And then it was ‘Oh my god, oh my god, oh my god.’ My partner was with me, and I told him, ‘You aren’t going to believe this.’”

Fernando de la Cerda, minister counselor at the Guatemalan Embassy in Washington, said that Mrs. Clinton apologized to President Colom in her Thursday phone call. “We thank the United States for its transparency in telling us the facts,” he said.

Asked about the possibility of reparations for survivors or descendants, Mr. de la Cerda said that was still unclear.

The public response on the Web sites of Guatemalan news outlets was furious. One commenter, Cesar Duran, on the site of Prensa Libre wrote: “APOLOGIES … please … this is what has come to light, but what is still hidden? They should pay an indemnity to the state of Guatemala, not just apologize.”

Dr. Mark Siegler, director of the Maclean Center for Clinical Medical Ethics at the University of Chicago’s medical school, said he was stunned. “This is shocking,” Dr. Siegler said. “This is much worse than Tuskegee—at least those men were infected by natural means.”

He added: “It’s ironic—no, it’s worse than that, it’s appalling—that, at the same time as the United States was prosecuting Nazi doctors for crimes against humanity, the U.S. government was supporting research that placed human subjects at enormous risk.”

The Nuremberg trials of Nazi doctors who experimented on concentration camp inmates and prisoners led to a code of ethics, though it had no force of law. In the 1964 Helsinki Declaration, the medical associations of many countries adopted a code.

The Tuskegee scandal and the hearings into it conducted by Senator Edward M. Kennedy became the basis for the 1981 American laws governing research on human subjects, Dr. Siegler said.

It was preceded by other domestic scandals. From 1963 to 1966, researchers at the Willowbrook State School on Staten Island infected retarded children with hepatitis to test gamma globulin against it. And in 1963, elderly patients at the Brooklyn Jewish Chronic Disease Hospital were injected with live cancer cells to see if they caused tumors.

Elisabeth Malkin contributed reporting from Mexico City.

October 1, 2010